Life as a chief of medicine-Taking future hospital guidance to the front line.

The Future Hospital Commission developed a comprehensive and ambitious proposal of how hospitals should be run, with clinical leadership at its heart. A medical division led by the chief of medicine was integral to the vision and these senior physicians would be central to the running of hospitals alongside managers. The real-world experiences over 8 years of one chief of medicine are explored and compared to the guidance set out by the Future Hospital Commission, with an emphasis on interdisciplinary triumvirate working, values, behaviours, quality improvement and the impact of crises like the COVID pandemic. The chief of medicine role can play an important part in delivering the outcomes promoted by the Future Hospital Commission, but the role is likely to vary throughout the NHS dependent on local factors. Future guidance could focus on equipping the leaders of the future to design and improve services, and to develop the multiprofessional teams that meet the needs of their specific challenges that they face.

Setting epidemiological cut-off values relevant to MIC and disc diffusion data for Aeromonas salmonicida generated by a standard method.

The Clinical and Laboratory Standards Institute has published epidemiological cut-off values for susceptibility data generated at 22°°C and read after 44-48 h for florfenicol, oxolinic acid and oxytetracycline against Aeromonas salmonicida. The cut-off values for the minimum inhibitory concentration (MIC) and disc diffusion were derived from data obtained by 1 laboratory and 2 laboratories respectively. The present work reports the generation of susceptibility data from additional laboratories and the calculation of provisional cut-off values from aggregations of these data with previously published data. With respect to MIC data, the provisional cut-off values, derived from aggregations of the data from 4 laboratories, were ≤4 µg ml-1 for florfenicol, ≤0.0625 µg ml-1 for oxolinic acid and ≤1 µg ml-1 for oxytetracycline. For disc diffusion data, the provisional cut-off values derived from aggregations of the data from 5 laboratories were ≥30 mm for florfenicol, ≥32 mm for oxolinic acid and ≥25 mm for oxytetracycline. In addition, a cut-off value of ≥29 mm for ampicillin was derived from the aggregation of data from 4 laboratories.

Exact Bahadur Slope for combining independent tests in the case of the Pareto distribution.

In this paper, we compared the Exact Bahadur Slope (EBS) and the asymptotic relative efficiency of four combination methods for testing a single hypothesis against a one-sided alternative in the case of Pareto distribution when the number of tests tends to infinity. These methods combine the p-value of the corresponding test into one overall test. Fisher's, logistic, the sum of p-values, and inverse normal procedures are the four techniques used in our study. To study the performance of the combination methods, we derived the EBS expressions and compared the limit ratios locally and for large values of the shape parameter of the Pareto distribution via EBS. We also computed the EBS numerically for when the parameter of interest starts moving from the null space and applied the four methods to real data examples. We found that Fisher's method uniformly dominates the other methods in terms of EBS.

Public values to guide childhood vaccination mandates: A report on four Australian community juries.

OBJECTIVE: Governments use vaccination mandates, of different degrees of coerciveness, to encourage or require childhood vaccination. We elicited the views of well-informed community members on the public acceptability of using childhood vaccination mandates in Australia. METHODS: Four community juries were conducted in Canberra, Launceston, Cairns and Melbourne, Australia between 2021 and 2022. We recruited 51 participants from diverse backgrounds, genders and ages through random digit dialling and social media. Two juries were held in metropolitan areas, and two in regional/rural settings. Outcome measures included jury verdicts and reasons in response to structured questions. RESULTS: All juries were concerned about collective protection and individual rights but prioritised the former over the latter. A majority in all juries supported mandates but juries disagreed with respect to the appropriate mandate types. All juries endorsed using the least restrictive or coercive means to encourage vaccination (providing incentives or education, e.g.) before imposing penalties such as financial losses and school exclusions. The overriding view was that it is fairer to place a direct burden on parents rather than children and that mandates should be designed to avoid inequitable impacts on less advantaged groups in society. Many jurors found conscientious objection acceptable as a controlled option for resolute refusers, provided that overall vaccination coverage remains high. CONCLUSION: This paper gives policymakers access to the reasons that Australians have for supporting or opposing different mandates under conditions of high knowledge, understanding and deliberation regarding policy options. Sustaining high rates of vaccination requires high levels of co-operation between governments, public health actors and the public. Our findings highlight the importance of considering public values in the design and implementation of vaccination mandates. PATIENT AND PUBLIC INVOLVEMENT: We sought input from individuals who did and did not vaccinate during the study design. The views and perspectives of nonvaccinating parents were presented in the evidence to juries. We deliberately excluded nonvaccinating individuals from participating, as the divisive and often hostile nature of the topic, and their minority status, made it difficult to ensure they would feel safe as members of the jury without overrepresenting their perspective in the sample. Two related projects engaged directly with these parents.

Latent profile analysis of nurses' moral courage: a professional values perspective.

INTRODUCTION: Nurses' moral courage (NMC) enhances care quality and patient safety. Nurses' professional values promote ethical adherence, moral obligation fulfillment, and compliance to prevent ethical violations. It is necessary to explore the current status and influencing factors of moral courage from the perspective of professional values. AIM: To investigate the current situation of nurses' moral courage, analyze the latent profiles of nurses' moral courage, and explore the influencing factors from the perspective of professional values. RESEARCH DESIGN: A cross-sectional design was employed. PARTICIPANTS AND RESEARCH CONTEXT: Data were collected through convenient sampling at a tertiary hospital during May 2023 in Wuhan, Hubei province, China. A self-designed web-based questionnaire consisting of demographic characteristics, the Chinese Nurses' Professional Values Scale-Revised Version (NPVS-R-CV) and the Nurses' Moral Courage Scale (NMCS) were used for the cross-sectional survey. Latent profile analysis was conducted using the results of 3 explicit indexes of NMCS, and multivariate logistic regression was used to analyze the influencing factors of NMC. ETHICAL CONSIDERATIONS: Research ethics approval (with the code of TJ- IRB 20220543) was obtained from Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. FINDINGS: This study included 966 nurses, predominantly female and under 30 years old, with 91.10% holding a bachelor's degree. Latent profile analysis identified three moral courage profiles: low-level (31.5%), medium-level (47.2%), and high-level (21.3%). Multivariate logistic regression analysis showed significant positive correlations between professional values and moral courage, with head nurses being significantly more likely to exhibit high moral courage (OR = 3.586, p = 0.013). CONCLUSIONS: The moral courage of nurses can be classified into 3 subgroups. Nurses' professional values positively correlate with moral courage, with head nurses showing significantly higher levels of moral courage. Strengthening professional values through training can enhance ethical behavior in nursing, potentially improving patient care and safety.

Adaptive Multiple Comparisons With the Best.

Subset selection methods aim to choose a nonempty subset of populations including a best population with some prespecified probability. An example application involves location parameters that quantify yields in agriculture to select the best wheat variety. This is quite different from variable selection problems, for instance, in regression. Unfortunately, subset selection methods can become very conservative when the parameter configuration is not least favorable. This will lead to a selection of many non-best populations, making the set of selected populations less informative. To solve this issue, we propose less conservative adaptive approaches based on estimating the number of best populations. We also discuss variants of our adaptive approaches that are applicable when the sample sizes and/or variances differ between populations. Using simulations, we show that our methods yield a desirable performance. As an illustration of potential gains, we apply them to two real datasets, one on the yield of wheat varieties and the other obtained via genome sequencing of repeated samples.

Cultural roots of the myopia boom in Confucian Asia and their implications.

Current evidence implicates educational pressures and reduced outdoor time as major causes of myopia. This paper examines the ongoing battle against the myopia epidemic in East Asia, including its cultural offshoots such as Singapore, where over 80% of young adults are myopic. East Asian societies share deeply rooted Confucian values that attach great importance to education and familial obligations, with heavy parental investment in education and the perception that academic excellence reflects filial piety. Coupled with a strong emphasis on standardised test results, East Asian children face intense educational pressures from a young age. Existing education-based myopia prevention strategies focus either on top-down school reforms to promote more outdoor time for students during school hours or on bottom-up awareness initiatives encouraging lifestyle changes. However, the entrenched Confucian worldview suggests that more extensive top-down reforms aimed at reducing competition in education, combined with widespread bottom-up awareness initiatives targeting the public-particularly parents, given their active involvement in children's education outside of school-may be required to truly turn the tide on myopia.

Statistical analysis of the effect of socio-political factors on individual life satisfaction.

Life satisfaction refers to an individual's cognitive evaluation of the quality of their life. The aim of the present study is to develop the current understanding of how perceived corruption, attitudes toward migration, perceived security, and strength of national identity influence life satisfaction. Additionally, the study examines how demographic variables of relationship status, social class, sex, religious affiliation, and country impact life satisfaction in the provided cultural context. Ordinal logistic regression analysis, Confirmatory Factor Analysis, and Structural Equation Modeling are used to analyze data from the World Values Survey. Findings from the analyses indicate that perceived corruption, perceived security, and strength of national identity have a significant impact on life satisfaction, whereas migration has an indirect effect on life satisfaction through perceived security. The present research can develop our current understanding of life satisfaction from a socio-political perspective.

Complete Blood Count Values Over Time in Young Children During the Dengue Virus Epidemic in the Dominican Republic From 2018 to 2020.

Background: Dengue fever (DF) is a mosquito-borne illness with substantial economic and societal impact. Understanding laboratory trends of hospitalized Dominican Republic (DR) pediatric patients could help develop screening procedures in low-resourced settings. We sought to describe laboratory findings over time in DR children with DF and DF severity from 2018 to 2020. Methods: Clinical information was obtained prospectively from recruited children with DF. Complete blood count (CBC) laboratory measures were assessed across Days 1-10 of fever. Participants were classified as DF-negative and DF-positive and grouped by severity. We assessed associations of DF severity with demographics, clinical characteristics, and peripheral blood studies. Using linear mixed-models, we assessed if hematologic values/trajectories differed by DF status/severity. Results: A total of 597 of 1101 with a DF clinical diagnosis were serologically evaluated, and 574 (471 DF-positive) met inclusion criteria. In DF, platelet count and hemoglobin were higher on earlier days of fever (p < = 0.0017). Eighty had severe DF. Severe DF risk was associated with thrombocytopenia, intraillness anemia, and leukocytosis, differing by fever day (p < = 0.001). Conclusions: In a pediatric hospitalized DR cohort, we found marked anemia in late stages of severe DF, unlike the typically seen hemoconcentration. These findings, paired with clinical symptom changes over time, may help guide risk-stratified screenings for resource-limited settings.

The nurses' clinical environment belongingness and professional identity: The mediating role of professional values.

BACKGROUND: Belonging to the clinical environment and the professional values of the performers play a role in forming a professional identity. Therefore, it is necessary to understand the degree of connection among these concepts. AIM: This study aimed to examine the mediating effects of professional values on the relationship between nurses' clinical environment belongingness and professional identity. DESIGN: In the present study, a descriptive cross-sectional multicenter design was used. PARTICIPANTS AND RESEARCH CONTEXT: A convenient sample of 635 nurses recruited from three hospitals in Fars Province, Southern Iran, from September 2023 to January 2024. Nurses Professional Values Scale-Revised, Clinical Environment Belongingness Scale, and Professional Identity Scale were used to collect the data. The mediation model was analyzed using SPSS v27 and the Process Macro 4.0. ETHICAL CONSIDERATIONS: The protocol of this study was approved by the Research Ethics Committee of Fasa University of Medical Sciences, and informed consent was obtained from all nurses. The study conforms to the principles outlined in the Declaration of Helsinki. RESULTS: Based on the results of regression analysis, clinical environment belongingness had a positive and significant impact on professional identity (ß = 0.366, p < 0.001) and professional value (ß = 0.676, p < 0.001). Professional value significantly predicted professional identity (ß = 0.170, p < 0.001). The indirect effect of clinical environment belongingness on professional identity via professional values was statistically significant (ß = 0.115, SE = 0.024, 95% CI = [0.068, 0.162]), and this effect was directly (ß = 0.336, SE = 0.034, 95% CI = [0.297, 0.434]) significant. CONCLUSIONS: The new theoretical framework for nurses developed in this study can contribute to professional development. It is further recommended that the promotion of professional value and clinical environment belongingness may be effective in enhancing the professional identity of the nursing staff, as indicated by the results.

Does maternity care in Australia align with the national maternity Strategy? Findings from a national survey of women's experiences.

BACKGROUND: Women Centred Care: Strategic directions for Australian maternity services (the Strategy), released in November 2019, provides national guidance on effective maternity care provision. The Strategy is structured around four core values (safety, respect, choice, and access) underpinning twelve woman-centred care principles. AIM: To explore whether the experiences of women who accessed Australian maternity services were aligned with the Strategy's values and principles. METHODS: Women who had completed an entire maternity care episode in Australia between January 2020 and June 2023 were invited to participate in an online survey. Women's experiences according to the Strategy's values and principles and their association with model of care, age, place of residence, educational attainment, and household income are reported. FINDINGS: The survey was completed by 1750 women. A proportion of women perceived the Strategy's values were not reflected in the care they experienced. At its lowest, only 50.3 % of women received an aspect of care that mostly or always aligned with the values, and 85.9 % at its highest. Women in private models of care were more likely to experience care according to the Strategy. Women in standard and high-risk public hospital care, rural/remote dwelling women, and younger women were less likely to experience care accordingly. Care was universally perceived to be worse in the postnatal period. CONCLUSION: Despite articulating how Australian maternity care should be provided, the intent of the Strategy has not been fully realised. Inequities exist in women's access to and experiences of care across the entire maternity episode.

Responsiveness of the Oswestry Disability Index and Zurich Claudication Questionnaire in patients with lumbar spinal stenosis: evaluation of surgically treated patients from the NORDSTEN study.

PURPOSE: To evaluate the responsiveness of the original low back pain specific Oswestry Disability Index (ODI) and the spinal stenosis specific Zürich Claudication Questionnaire (ZCQ), and to investigate cut-off values for clinical "success" for ODI and ZCQ in surgically treated patients with lumbar spinal stenosis (LSS). METHODS: We included 601 LSS patients (218 with, 383 without degenerative spondylolisthesis) from the NORDSTEN trials. Outcome measures included ODI and ZCQ (symptom severity and physical function scales) with three alternative response parameters: scores at follow-up, absolute and relative changes from baseline to two-year follow-up. Effect size and standardised response mean evaluated internal responsiveness. External responsiveness was assessed by the Spearman rank correlation between patient-reported global perceived effect scale (GPE) and ODI and ZCQ, and receiver operating characteristics (ROC). We evaluated which cut-off values could maximise the percentage of correctly classified patients according to the GPE-anchor "completely recovered" / "much improved" for each parameter. RESULTS: Internal and external responsiveness were high for all three indices with effect sizes, standardized response means, ROC and corresponding area under the curve > 0.8. Correlations with GPE responses were moderate (> 0.50) for absolute change and strong (> 0.67) for relative change and follow-up scores. The 30% ODI relative change cut-off correctly classified 81% of patients to "success", within a range of accurate cut-offs according to the GPE-anchor. CONCLUSION: ODI and ZCQ demonstrate comparable responsiveness in evaluating outcomes for surgically treated LSS patients. The 30% ODI threshold was consistent with treatment "success" in NORDSTEN trials. TRIAL REGISTRATION: ClinicalTrials.gov; NCT02007083 10/12/2013, NCT02051374 31/01/2014 and NCT03562936 20/06/2018.

"Eco-conscious appetites: Investigating organic food purchase intentions through consumption values, empowered by environmental self-identity and analyzed using MGA - Baltic insights".

Growing consumer interest in organic food has attracted the attention of the academic community. While the existing literature broadly examines the acceptability of organic food, there is a recognized need to delve deeper into consumer values. This study fills this gap by applying the theory of consumer values. The data was collected as part of a survey of 1000 Lithuanian consumers to evaluate the proposed hypotheses empirically. The results show that functional value (quality), social value, conditional value, emotional value, and epistemic value positively influence purchase intention for organic food. Conversely, functional value (price) does not significantly impact the purchase intention of organic food. Furthermore, the study recognizes a significant moderating impact of environmental self-identity in shaping the relationship between conditional value, emotional value, and purchase intention of organic food. In addition, a multi-group analysis examines notable differences between consumer groups based on gender, education, age, and income. The results indicate significant group differences, showing that purchasing behavior among women, younger consumers, those with higher incomes, and those with higher education levels are more susceptible to these values. This research improves our understanding of consumer values regarding organic food in Lithuania and provides valuable guidance to managers and policymakers. By recognizing the intricate interplay between different values and the influence of environmental self-identity, stakeholders can better tailor their marketing efforts and policies to meet the unique preferences of different consumer groups, ultimately promoting the growth of the organic food market.

Individual work-motive values: determinants and consequences for the appraisal of specific health-related work characteristics.

The objectives of the present study were to determine whether (I) work-motive values influence the appraisal of specific work characteristics of significance for health and function and (II) subject variables impact work-motive values. Two aspects of work-motive values were studied: values that assign importance to pursuing one's personal goals and interests, internally based work-motive values (IntWMVs), and values that assign importance to external factors, externally based work-motive values (ExtWMVs). These aspects of motive values, age, gender, skill level, managerial role, and specific psychosocial work characteristics were analyzed in a cross-sectional sample of 12,994 employees in 101 private and public organizations. Two-year follow-up prospective data from 6,252 employees in 69 organizations elucidated whether associations were stable over time. The results showed that IntWMV influenced reports of levels of control of decisions, empowering leadership, innovative climate, quantitative demands, feedback from work, and self-leadership. ExtWMVs were most consistently associated with role clarity. Skill level and managerial role were associated with reporting higher levels of IntWMVs and lower ExtWMVs. In conclusion, the present data support the assumption that work-motive values influence the appraisal, reporting, and consequently measurements of work characteristics. Managers differ from subordinates in work-motive values and may face challenges in ascertaining and supporting subordinates' needs.

Forest plant indicator values for moisture reflect atmospheric vapour pressure deficit rather than soil water content.

Soil moisture shapes ecological patterns and processes, but it is difficult to continuously measure soil moisture variability across the landscape. To overcome these limitations, soil moisture is often bioindicated using community-weighted means of the Ellenberg indicator values of vascular plant species. However, the ecology and distribution of plant species reflect soil water supply as well as atmospheric water demand. Therefore, we hypothesized that Ellenberg moisture values can also reflect atmospheric water demand expressed as a vapour pressure deficit (VPD). To test this hypothesis, we disentangled the relationships among soil water content, atmospheric vapour pressure deficit, and Ellenberg moisture values in the understory plant communities of temperate broadleaved forests in central Europe. Ellenberg moisture values reflected atmospheric VPD rather than soil water content consistently across local, landscape, and regional spatial scales, regardless of vegetation plot size, depth as well as method of soil moisture measurement. Using in situ microclimate measurements, we discovered that forest plant indicator values for moisture reflect an atmospheric VPD rather than soil water content. Many ecological patterns and processes correlated with Ellenberg moisture values and previously attributed to soil water supply are thus more likely driven by atmospheric water demand.

Compromised informed consent due to functional health literacy challenges in Chinese hospitals.

BACKGROUND: Medical informed consent stands as an ethical and legal requisite preceding any medical intervention. Hospitalized patients face functional health literacy (FHL) challenges when dealing with informed consent forms (ICFs). The legitimacy of ICFs and informed consent procedures in China remains substantially undisclosed. The study's aim was to investigate if Chinese patients have adequate FHL to be truly informed before providing medical consent. METHODS: In this cross-sectional, structured interview-based study, FHL was assessed within the context of the informed consent scenarios in two teaching hospitals (a 1500-bed general tertiary hospital and a 700-bed cancer hospital) affiliated with Shantou University Medical College. Twenty-seven patients admitted across clinical departments, along with their relatives (n = 59), were enrolled in the study after obtaining informed consent. The participants underwent a three-step assessment with two selected ICFs -teach-back skills, perceived understanding (perception), and informed knowledge (cognizance), with each component carrying a maximum score of 10. Data were analyzed with SPSS (version 22.0) for descriptive and inferential statistics, with consideration of significant P values as < 0.05. RESULTS: The median age (IQR and range) of participants was 35.5 (28 - 49 and 13 - 74) years. Most participants had only high school education (24.4%, 21/86) or below high school education (47.7%, 41/86). The median score (IQR) of FHL assessments-teach-back, perception, and cognizance-was 4.0 (2.5, 5.8), 8.0 (6.8, 8.8), and 6.5 (5.5, 8.0) out of 10, respectively. A moderate correlation was observed between the scores of cognizance and teach-back (r = 0.359, P = 0.002) or perception (r = 0.437, P < 0.001). Multivariate linear regression analysis predicted being a patient and having lower education levels as independent risk factors of inadequate FHL (Ps = 0.001). Lack of patient-centeredness in ICFs, time constraints, and poor clinical communication were identified as barriers impeding informed consent. CONCLUSIONS: This study demonstrates inadequacy in personal FHL and impaired organizational HL, resulting in compromised informed consent in Chinese teaching hospitals. As a remedy, we propose improving the quality of ICFs and institutionally mandated outcome-focused training on informed consent for all concerned clinicians to enhance medical ethics, ensure quality health care, address patient values, and mitigate potential medical conflicts.

Addressing critical gaps in protected area coverage for bird habitats in China.

Currently, protected areas cover approximately 14% of the Earth's land surface, yet 12.2% of the world's bird species remain unprotected by any designated areas and face significant threats. This study investigates the current status of bird conservation in China, aiming to evaluate the effectiveness of existing protected areas, analyze why certain bird species are not adequately protected, and propose strategies for optimizing protected area configurations. Utilizing citizen science data and the zonation optimization algorithm, we comprehensively assessed the conservation value of birds in China. We then employed anthropogenic stressor data to evaluate the conservation of threatened bird habitats through a binary conflict intensity model. Finally, we conducted a spatial overlap analysis to determine the coverage and effectiveness of Chinese nature reserves in regions with high conservation value and high conflict risk. Our findings indicate that only 10.0% of the highest conservation value bird habitats are covered by protected areas, and just 7.3% of these protected areas effectively safeguard these critical habitats. Additionally, only 5.9% of bird habitats impacted by human activity conflicts are within protected areas, and merely 22.0% of the total protected areas can effectively conserve high conflict risk habitats. Overall, China's current protected area system has substantial shortcomings in safeguarding bird habitats and requires further optimization and expansion to maximize conservation benefits.

The psychology of pandemic policy support: unraveling the complex interplay of personal values and value congruence across 20 European countries.

OBJECTIVES: We explored the roles of personal values and value congruence-the alignment between individual and national values-in predicting public support for pandemic restrictions across 20 European countries. STUDY DESIGN: Cross-sectional study. METHODS: We analyzed multinational European survey data (N = 34,356) using Schwartz's values theory and person-environment fit theory. Multilevel polynomial regression was employed to assess the linear and curvilinear effects of personal values on policy support. Multilevel Euclidean similarity analysis and response surface analysis were conducted to evaluate the impact of value congruence and delineate nuanced congruence patterns. RESULTS: Findings revealed that extreme levels of security, conformity, stimulation, hedonism, and achievement values were associated with decreased policy support. Value congruence with security, conformity, and benevolence increased support, while congruence with stimulation, hedonism, and achievement reduced it. High congruence between personal and national social focus values significantly boosted policy support. Extreme mismatches in self-direction values amplified support. Societal power exceeding personal power also increased support. Matched levels of hedonism motivated greater support, while stimulation and achievement value (in)congruence showed little impact. CONCLUSIONS: We highlight the differential effects of personal values and value congruence on public attitudes toward pandemic restrictions. The findings underscore the importance of considering the interplay between individual and societal values when designing and implementing effective pandemic response strategies.

Characterizing and decoding the key odor compounds of Spirulina platensis at different processing stages by sensomics.

Processing is an indispensable technology in the preparation of Spirulina platensis (S. platensis). The key odorants in liquids, muds, and powders from S. platensis (NM and GZ) were characterized. A total of 90 odorants were identified and 41 odorants were sniffed with the flavor dilution (FD) factors ranging from 1 to 729. Among them, nonanal, decanal, d-limonene, ß-cyclocitral, and ß-ionone with FD factors ≥1 were detected in S. platensis during the whole processing stages. In addition, heptanal, (E, E)-2,4-nonadienal, trans-4,5-epoxy-(E)-2-decenal, 1-hepten-3-one, isophorone, 3-ethyl-2,5-dimethylpyrazine, and α-ionone exhibited higher odor activity values in powders; ß-myrcene, methional, and S-methyl methanethiosulphonate were key odorants in muds; while trans-3-penten-2-ol was key odorant in liquids. Besides, the GZ-mud presented stronger earthy and fishy odor than NM-mud. S. platensis powders have the stronger grassy odor, roasted odor, and marine odor than S. platensis muds. Overall, drying process promotes the formation of aldehydes, heterocyclic compounds, and terpenoids.